ABSTRACT
Endovascular venoplasty with iliofemoral venous stenting has become first-line therapy for post-thrombotic iliofemoral venous obstructive lesions. As the risk of acute complications decreases, the risk of post-thrombotic syndrome or secondary chronic venous hypertension increases. Most frequently, post-thrombotic disease will be segmental, involving the entire common iliac vein, external iliac vein, and/or common femoral vein. While cumulative stent patency is lower in post-thrombotic patients compared to their non-thrombotic counterparts, encouraging and sustaining results are still routine. The most difficult ulcers to heal are post-thrombotic patients with large ulcers with significant deep venous reflux. Deep venous reflux, whether attributable to persistent obstruction and subsequent elevation of pressure or to primary valvular damage from thrombosis and fibrosis, serves as another source of increased pressures in the calf and foot. Once wire access has been obtained across the occlusion or stenotic venous segments, intravascular ultrasound is performed.
